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General NPI Number Information
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NPI Number | 1497372916
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Entity Type | Organization
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Legal Business Name | WAVE SCIENTIFIC LLC
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Dates
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Enumeration Date | 06/30/2020
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Last Update Date | 06/30/2020
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Provider Practice Location Address
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Address Line | 12300 ALT A1A STE 105
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-2206
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Country | US
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Telephone | 561-678-2311
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Fax | 561-283-0511
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Provider Business Mailing Address
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Address Line | 12300 ALT A1A STE 105
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-2206
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ESQ
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Name | HARRY J ROSS
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Credential | ESQ
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Telephone | 561-482-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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